Description
Indication
Treatment of erectile dysfunction (ED)
Eligibility / Screening
Exclude or use caution in patients with:
Concurrent nitrate use (nitroglycerin, isosorbide)
Severe cardiovascular disease
Recent heart attack or stroke
Uncontrolled hypertension or hypotension
Significant liver impairment
Severe kidney disease
Retinitis pigmentosa
History of priapism
Concurrent PDE5 inhibitor use
Unstable angina
Severe heart failure
Typical Dosing
Starting Dose
Sildenafil 25 mg to 50 mg PO as needed
Standard Dose
Sildenafil 50 mg PO approximately 30–60 minutes before sexual activity
Max Dose
Sildenafil 100 mg PO once daily as needed
Frequency
No more than once per 24 hours
Administration Instructions
Take on an empty stomach for best absorption
High-fat meals may delay onset
Avoid excessive alcohol use
Sexual stimulation is still required for efficacy
Common Side Effects
Headache
Facial flushing
Nasal congestion
Dyspepsia
Dizziness
Visual disturbances (blue tint/blurred vision)
Serious Adverse Events / Stop Use
Chest pain
Sudden vision loss
Sudden hearing loss
Priapism lasting >4 hours
Severe hypotension
Common Telehealth Follow-Up Questions
Improvement in erection quality?
Side effects?
Duration of effect?
Need for dose adjustment?
Concurrent medication changes?
Example Prescription Sig
Sildenafil 50 mg Tablets
Sig: Take 1 tablet by mouth 30–60 minutes prior to sexual activity as needed. Do not exceed 1 dose in 24 hours.
Dispense: 10–30 tablets
Refills: 1–3
Alternative Titration
Increase to 100 mg if ineffective and tolerated
Decrease to 25 mg if side effects occur or patient is elderly/sensitive
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